Basic Information
| Provider Information | |||||||||
| NPI: | 1871502955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEANE | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | A.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 RIVER OAKS DR | ||||||||
| Address2: | |||||||||
| City: | CALUMET CITY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604095802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088621290 | ||||||||
| FaxNumber: | 7088626447 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 RIVER OAKS DR | ||||||||
| Address2: | |||||||||
| City: | CALUMET CITY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604095802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088621290 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2006 | ||||||||
| LastUpdateDate: | 07/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 209001890 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.